First Aid Kits: the Good, the Bad, and the Downright Ugly

All kinds of kits are available. What is required, what works--and are the two compatible?

• By Barbara C. Burton, M.Ed.
• Apr 01, 2003

PERHAPS before discussing first aid kits, we should consider the question, "What is first aid?" Does it refer to treatment delivered prior to more definitive medical care available at a clinic or hospital? Is it simply the placing an adhesive bandage over a small cut? Is it an aspirin taken from the cabinet for the treatment of a headache? Does it involve splinting an ulnar fracture? Because the way you define first aid also defines your concept of a first aid kit and the training needed to use the kit's contents.

OSHA's standard on first aid is brief. The standard mandates "the ready availability of medical personnel for advice and consultation on matters of plant health," people who are adequately trained to render first aid "in the absence of an infirmary, clinic, or hospital in near proximity" to the workplace, readily available first aid kits, and suitable facilities "for quick drenching or flushing of the eyes and body" in work areas where a risk exists. In interpretive documents, OSHA defines "near proximity" of medical assistance as three to five minutes. As for the first aid kits, OSHA recommends looking to the American National Standards Institute (ANSI), medical professionals, hospital emergency departments, and fire/rescue departments for guidance on first aid kits. However, OSHA also recognizes that companies may have specific hazards requiring correlating medical supplies.

When it comes right down to it, there are "official" first aid kits, compliance first aid kits, kits to hang on the wall, kits to put on a shelf, unitized kits, kits to carry, and kits containing everything but the kitchen sink. What is required, what works--and are the two compatible?

ANSI's current minimum requirements for first aid kit contents include:

• Gauze pads (at least 4 x 4 inches)
• Two large gauze pads (at least 8 x 10 inches)
• Box adhesive bandages (band-aids)
• One package gauze roller bandage at least 2 inches wide
• Two triangular bandages
• Wound-cleaning agent such as sealed moistened towelettes
• Scissors
• At least one blanket
• Tweezers
• Adhesive tape
• Latex gloves
• Resuscitation equipment such as resuscitation bag, airway, or pocket mask
• Two elastic wraps
• Splint
• Directions for requesting emergency assistance

Lots of Confusion
ANSI does not specify the size of the elastic wraps or the type of splints. It also does not specify what first aid providers are supposed to do with those supplies; that is entirely up to the company and its definition of first aid.

"I have noticed that there are two distinct types of situations that are commonly referred to as 'first aid,' " said Susan Harrelson, corporate counsel of the James Truss Company, Inc. of Las Vegas, Nev. "One is where the aid really is 'first,' in that it is preliminary to more advanced medical treatment. An example would be stopping bleeding from a cut until the injured person can get to a doctor to get it sutured. The other is where you cut yourself in a minor way and go get a BandAid® to put it on. We see the second kind of 'first aid' almost exclusively. I have found that the two uses of the term cause a lot of confusion."

Echoing Harrelson's ideas is Rebecca Walther, senior EHS specialist at Genencor International, Inc, which is based in Palo Alto, Calif. "Most often the injury involves the use of a BandAid®. When anything more significant happens," said Walther, "either 911 is called to summon emergency medical personnel or the individual is taken to the Occupational Medical facility or Emergency Department."

Perhaps therein lies at least part of the problem. James Truss Company used the ANSI list as a guideline for its first aid kits, focusing on items that lend themselves to the treatment of minor injuries. What happens when the emergency is not minor, something that can be handled with an adhesive bandage? While having employees call 911 is an excellent beginning, what do they do until a first response unit or ambulance arrives? Will the supplies be up to the task?

New National Guidelines for Training
Ralph Shenefelt, general manager of the American Safety and Health Institute, said first aid kits "should reflect what first aid providers can do, i.e., they should be performance-based. That raises the question of what knowledge and skills first aid providers in occupational setting should have. I believe that question has been answered through the NGFATOS (National Guidelines on First Aid Training in Occupational Settings) project (www.NGFATOS.net) and, most recently, ASTM Standard F 2171-02 'Standard Guideline Defining the Performance of First Aid Providers in Occupational Settings' (published April 4, 2002)."

"First aid kits should contain . . . BSI (body substance isolation), ventilation barriers, dressings and bandages to manage serious bleeding, and maybe a couple cold packs for 'painful, swollen, or deformed' limbs," Shenefelt added. "I think of this not so much as a first aid kit, which tends to bring up images of BandAids ® antiseptic wipes and over-the-counter medications for personal comfort, but as an 'Emergency Kit.' Add an AED and a simple oxygen unit (and appropriate training), and you have a 'Medical Emergency Response Kit.' "

Commercial first aid kits with specialty bandages, over-the-counter medications, antiseptics, etc. "are great for managing minor first aid problems and should be available for the use by all injured employees--but a Medical Emergency Response Kit should be ready and available for use by trained first aid providers following current standards and guidelines for their scope of care," he said.

Handling Requests for Other Supplies
Jon Oliver is the safety coordinator in the Risk Management Division for Sonoma County, Calif. His safety realm encompasses 72 buildings: everything from the county courthouse to the airport and regional parks, to the jail, landfill, and the fairgrounds. Oliver has set minimum requirements for the hundreds of first aid kits in those buildings. Those are:

This is the minimum fill, Oliver said. He encourages each facility to determine how many of the above items it needs. Facilities also are free to have additional items, as long as they are intrinsically safe. "One of my big concerns is keeping 'dangerous' stuff out of first aid kits," he explained.

Sonoma County employees have made requests; some have been approved and others have been denied. Oliver has granted requests for larger gauze pads, knuckle bandages, antiseptic, and larger adhesive pads. When employees asked for smelling salts, snake-bite kits, salt tablets, or tourniquets, Oliver has turned them down. A request to stock Epi-Pens®, a treatment for severe allergic reactions, was met with a slightly more emphatic "No!"

"First aid kits may not contain prescription or over-the-counter medications such as aspirin, Ibuprofen, decongestants, sinus relief, etc. These are not first aid items. Employees who require these medications are encouraged to bring them to work for their personal use," he said.

Oliver used OSHA and ANSI guidelines for assistance in preparing his minimum fill list. Despite OSHA's reversal on old requirements to seek physician approval when developing first aid kits, Sonoma County did ask for assistance from a physician. "It is the law in California," he explained.

Dr. Jerry Tasset, M.D., Ph.D, believes consulting with a physician will save money and time when it comes to putting together a first aid kit. Tasset is regional medical director for Mercy Health Solutions, the occupational medicine service of Mercy Health Partners; he also feels companies must decide which emergencies they want to take care of, what types of injuries they get, and what equipment they need to manage the emergencies. "It's more than just having the equipment, it's training and preparing to utilize the equipment," he said.

As an example, Tasset cited the splints listed in ANSI's list of minimum first aid equipment. "I worry that there may be a lack of expertise available to treat the total patient," he said. Will first aid providers know to check above and below the possible fracture site before splinting? Will they understand the mechanism of injury to the point that they look for additional injuries elsewhere in the patient? He went to explain that a patient who falls straight down from a height and lands on both feet may have obvious fractures to his heels. The kinematics of blunt trauma would also suggest the patient might have serious spinal injuries, as well. Many people providing the most basic kind of first aid would not have the training to know this and therefore would not look for the additional injuries. "Just putting the first aid box on the wall is not a first aid program. Proper training must be included," Tasset said.

Start with ANSI's List
So, what is a company to do? How should you decide which first aid supplies to stock? Start by looking at the ANSI list. Think about using the resources around you, such as the local fire/rescue department. Look at your company's injury history.

Talk with members of the safety committee, if your company has one. If it doesn't, consider talking with several seasoned employees. Think about what you want first aid providers to accomplish prior to the arrival of Emergency Medical Services. Consider the type of training you will make available to first aid providers.

Keep in mind OSHA's caveat about providing for specific hazards in your workplace. This is a very good reason to consult with local emergency planning officials and emergency responders. Working with them as a team before an emergency occurs might save a great deal of heartache later.

This article originally appeared in the April 2003 issue of Occupational Health & Safety.